If you are a healthcare provider who treats patients with addictions, The Urge: Our History of Addiction, by Carl Erik Fisher (Penguin Press, 2022) is for you. It contains valuable information that you may not have read anywhere else and is a fantastic resource for healthcare providers who want to dig into the nature of addiction and understand how to best help their patients. It is thoughtful, poignant, and, true to Fisher’s academic training, wide ranging and extensively documented.
Fisher is Assistant Professor at Columbia University, in the Division of Law, Ethics, and Psychiatry. He’s also in recovery from substance use disorder. In the book he traces our human history of using substances, and how we have thought of addiction and treatment, mostly from the 1600s forward. Along the way, he tells his own story of increasing alcohol and stimulant use during med school and as a resident, until a psychotic break led him to the Physician Health Program.
Fisher challenges the notion that addiction is a disease like any other and lays out a convincing argument that addiction is a set of ideas that has changed over time. Now, the disease model of addiction supports the view that addictive behaviors are involuntary and uncontrollable, and people with addictions deserve compassion, not punishment. This contrasts with the older concept of addictive behaviors as a choice, in which people who can’t control their use should be punished. The truth, Fisher asserts, lies somewhere in between choice and compulsion.
Addiction, Fisher says, is “profoundly ordinary.” (p. 300) It is part of human nature, so it’s not surprising that researchers have yet to identify the “fundamental causes” of addiction. “It’s not that addiction is or is not a brain disease, or a social malady, or a universal response to suffering – it’s all of these things and none of them at the same time, because each level has something to add but cannot possibly tell the whole story.” (p. 281)
Fisher struggles with his own identity as someone with an addiction or in recovery from addiction. In the end he’s not convinced that he has a specific disease that makes him different than most people. Everyone at some point in their lives experiences a loss of control and power (p. 283) – sometimes that includes loss of control over drug use – and most reach some stable improvements in functioning and purpose in life (his definition of recovery).
Fisher calls on the medical profession to embrace the care of people with addictions and calls out stigmatizing attitudes as a tremendous barrier to care. (p. 288) He also exhorts us all to stop waging war on addiction. We must find ways to work with it, Fisher says, because “it is futile to wage war on our own nature.” (p. 300)
